This project will focus on first degree relatives of colorectal cancer cases who are at higher risk for developing this cancer than other individuals of the same age. Despite their increased risk, screening rates among these individuals experience psychological distress and that this distress may actually function as a barrier to screening. Therefore, the interventions in this project are designed to increase utilization of screening (FOBT and sigmoidoscopy/colonscopy) and decrease psychological distress in a population based sample of first degree relatives of colorectal cancer cases obtained from the statewide California Tumor Registry. Equal samples of randomly selected White, African American, and Latino cases, stratified by age at diagnosis of the case (<55 vs >55), will be obtained from the registry. First degree relatives (aged 50-74) identified by the cases will be administered a baseline telephone interview to assess eligibility, specific risk factors, past colorectal cancer screening, psychological distress and other variables from our theoretical framework. Only those relatives who have not had a FOBT in the past 12 months and/or sigmoidoscopy/colonoscopy in the past 3 years will be recruited for the intervention study. Following randomization, one intervention group (n=553) will receive a mailed personalized risk notification. The second intervention group (n=553) will receive the mailed intervention followed 1-2 weeks later by a psycho-educational telephone counseling intervention that will discuss each individual's personal colorectal cancer risk, explore personal barriers to screening and address psychological issues related to knowledge of risk status. The control group (n=553) will not receive any intervention material until after completion of the study. Subjects in all three groups will be contacted at 6 months post baseline to assess the effectiveness of the intervention in increasing adherence to colorectal cancer screening and reducing psychological distress. Secondary analysis will examine the predictive value of our theoretical framework in modeling adherence behavior and psychological distress. Cost effectiveness of the intervention will also be assessed.